Project Summary/Abstract: While the structure of the physis, or growth plate, has been well described by histology and radiologic measures, its physiology remains a mystery. Investigators have probed the physis and defined its makeup of extracellular matrix, collagen, the presence of certain growth factors, and characterized the histomorphometry of its cells. Yet how these different entities interact normally and in the face of disease is not known. Currently, surgeons employ techniques to slow growth and use implants to harness growth to correct deformity; but the mechanisms behind these interventions are elusive. Basic concepts such as what stimulates growth and how it can be harnessed is unknown; this remains the holy grail of pediatric orthopaedics. This topic is timely as surgical intervention is trending toward minimally invasive treatments. By defining the mechanisms by which the matrix, cells, and growth factors interact, pharmacologic and surgical interventions can be developed. In addition, a disproportionate share of musculoskeletal physeal diseases are found in obese children. As the obesity epidemic rages in our pediatric population, more children will suffer the consequences of physeal diseases. Pediatric patients will benefit from a deeper knowledge of the physis, but there are benefits to the larger scientific community as well. Understanding the endocrine cascade that works on the physis could give insights into cartilage disease beyond children, such as osteoarthritis and inflammatory arthritis. In order to begin to further our understanding of the physis and develop treatments, we have developed a scientific symposium to allow experts in both basic science and clinical medicine to discuss current knowledge about the growth plate, the effects of various stimuli on its structure, and to design novel treatments for physeal disorders. This symposium will include summaries of the current literature, original research presentations, and open and directed discussions over a two day interactive forum. The content and findings of the symposium will then be disseminated and available to the public through publication in a relevant orthopaedic journal.